GAMMA I.V

Indications

• Primary immunodeficiency disorders
• Secondary immunodeficiency (e.g. due to HIV infection)
• Chronic inflammatory demyelinating polyneuropathy (CIDP)
• Immune thrombocytopenic purpura (ITP)
• Kawasaki disease
• Prevention of infections in at-risk populations (e.g. following bone marrow transplant)

Dosage

Children: Refer to the BNF for Children for age-appropriate dosing guidelines; specific doses depend on the clinical condition and patient age.

Adults: Refer to specific guidelines for dosing based on indication; typically varies based on clinical scenario and patient condition.

Mechanism of action

Immunoglobulin exerts its effects primarily through the neutralization of pathogens and toxins, opsonization, and the activation of the complement system. It modulates immune responses by influencing the activity of various immune cells, including B cells, T cells, and macrophages, thereby enhancing antibody production and regulating inflammation.

Pharmacodynamics

The pharmacodynamics of immunoglobulin involve its ability to bind to specific antigens, effectively neutralizing them and facilitating their clearance. It also plays a crucial role in modulating the immune response, providing immediate passive immunity and promoting the establishment of active immunity over time. The diverse mechanisms through which immunoglobulin operates include antibody-dependent cell-mediated cytotoxicity (ADCC) and inhibition of pro-inflammatory cytokines.

Pharmacokinetics

Immunoglobulin is typically administered intravenously or subcutaneously. After administration, it is distributed throughout the extracellular space. The half-life of immunoglobulin varies but is generally in the range of 21 to 30 days, depending on the specific formulation and the patient's individual characteristics. It is primarily eliminated through the reticuloendothelial system, with catabolism occurring in various tissues.

Contra-indications

• Hypersensitivity to immunoglobulin preparations
• Selective IgA deficiency with a history of hypersensitivity
• Severe hyperprolinemia

Adverse effects

• Headache
• Nausea
• Fever
• Chills
• Fatigue
• Rash
• Anaphylactic reactions
• Thromboembolic events

Interactions

• Live attenuated vaccines may be less effective if administered concurrently with immunoglobulin therapy
• Caution is advised when administering with other blood products

Precautions

• Monitor for signs of anaphylaxis during and after administration
• Use with caution in patients with renal impairment
• Hydrate adequately to prevent renal dysfunction
• Consider the risk of thrombosis in patients with a history of thromboembolic events

Pregnancy

Immunoglobulin can be used during pregnancy if indicated, as it is considered safe based on available data.

Breast-feeding

Immunoglobulin is excreted in breast milk, but is generally considered safe during breastfeeding.

Storage

Store at 2-8 degrees Celsius. Do not freeze. Protect from light. Use before expiry date.

Formulations

• Intravenous immunoglobulin (IVIG)
• Subcutaneous immunoglobulin (SCIG)
• Intramuscular immunoglobulin (IMIG)

Indications

• Primary immunodeficiency syndromes
• Secondary immunodeficiency
• Immunomodulation in certain autoimmune disorders
• Prevention of infections in patients undergoing immunosuppressive therapy

Dosage

Children: Refer to the BNF for Children for specific dosing recommendations in pediatric patients, as it varies based on age, weight, and clinical condition.

Adults: Refer to the BNF for specific dosing recommendations for adults, as it varies based on clinical indications and patient circumstances.

Mechanism of action

Normal immunoglobulin works by providing a broad spectrum of antibodies that neutralize pathogens and enhance the immune response. These antibodies bind to pathogens, facilitating their removal by immune cells and providing immediate passive immunity against infections.

Pharmacodynamics

The pharmacodynamic effects of normal immunoglobulin include the neutralization of toxins and pathogens, opsonization, and enhancement of phagocytosis. It modulates immune responses and provides immediate humoral immunity, particularly in individuals with inadequate antibody production.

Pharmacokinetics

Normal immunoglobulin is administered intravenously or subcutaneously. After administration, it is distributed throughout the body, with a half-life of approximately 21 to 30 days. It is metabolized by the reticuloendothelial system, and the rate of clearance can vary based on individual patient factors and the presence of underlying conditions.

Interactions

• normal immunoglobulin + monoclonal antibodies: Severe (affects effects)
• normal immunoglobulin + dinutuximab: Severe (affects effects)
• normal immunoglobulin + live vaccines, measles, mumps and rubella vaccine, live, rotavirus vaccine, typhoid vaccine, oral, varicella-zoster vaccine: Unknown (decreases efficacy)
• normal immunoglobulin + bacillus Calmette-Guérin vaccine: Unknown (decreases efficacy)
• normal immunoglobulin + herpes-zoster vaccine: Unknown (decreases efficacy)
• normal immunoglobulin + live: Unknown (decreases efficacy)
• normal immunoglobulin + influenza vaccine, live: Unknown (decreases efficacy)

Pregnancy

Consult relevant guidelines for use in pregnancy.

Breast-feeding

Consult relevant guidelines for use during breastfeeding.

Storage

Store at 2-8°C. Do not freeze.